A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

Purpose:To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye.Method:Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge.Results:Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size.Conclusions:The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.     

Successful management of retinal tear post-laser in situ keratomileusis retreatment

PURPOSE: To report a successful case management of a retinal tear post-Laser in situ Keratomileusis (LASIK) and retreatment. RESULTS: A patient with the history of ocular trauma underwent LASIK procedure for myopic astigmatism. Three months post-LASIK, she received additional excimer laser treatment for a symptomatic persistent central island. One month later; the patient experienced a flap tear at the edge of a prior chorioretinal scar. Retinal tear repair was successfully accomplished by indirect application of photocoagulation laser without damage to the corneal flap. CONCLUSIONS: To date, no definitive causal relationship has been established between retinal tear(s) and corneal refractive surgery. This report describes a retinal tear and repair, post-LASIK retreatment. The use of the indirect binocular argon laser alleviates the need to compress the LASIK flap and minimizes the potential for creating flap folds and striae, especially in the early post operative period. Clinicians should be on alert to consider this possible complication, post-LASIK and excimer laser; especially within a population whose clinical findings place them at greater risk.     

Redistribution of strain and curvature in the porcine anterior lens capsule following a continuous circular capsulorhexis

Cataract surgery is the most commonly performed surgical procedure in the US, it consists of three steps: introduction of a hole into the lens capsule, removal of the clouded lens through this access hole, and insertion of an artificial lens. We hypothesize that errant behavior by the residual epithelial cells of the lens capsule following surgery are due, in part, to surgically-induced changes of the native stress and strain fields in the lens capsule. Because the capsular bag can be regarded mechanically as a membrane, here we study changes in curvature and strains due to the most common means of introducing the initial access hole: a continuous circular capsulorhexis (CCC). We show that a modest sized CCC increases circumferential strains and decreases meridional strains by up to approximately 20% and that curvatures change by up to approximately 13%, particularly near the edge of the CCC. We submit that such changes can induce mechanobiological responses that are responsible, in part, for some of the long-term complications following cataract surgery.     

Evaluation of the occlusion vertical dimension of complete dentures after microwave disinfection

doi: 10.1111/j.1741‐2358.2011.00567.x Evaluation of the occlusion vertical dimension of complete dentures after microwave disinfection Objectives: An increase in occlusal vertical dimension (OVD) after microwave disinfection may result in the need for adjustments in the complete dentures. This in vitro study evaluated the increase in OVD of maxillary complete dentures submitted to microwave disinfection protocols. Material and methods: Thirty sets of complete dentures were evaluated as follows: Group 1–15 sets had the maxillary complete dentures submitted to microwave disinfection (650 W/3 min), once a week, for 4 weeks. Group 2–15 sets had the maxillary complete dentures submitted to microwave disinfection (650 W/3 min), three times a week, for 4 weeks. The vertical dimension was measured with a micrometre (in mm) before disinfection protocols (baseline readings) and after each week of disinfection. Data were analysed using Wilcoxon and Friedman tests (α = 0.05). Results: For Group 1, no significant difference was found between the increases in OVD and zero, and no significant difference was found between the weeks. For Group 2, the increases in OVD were significantly greater than zero, and the Friedman test showed that weeks 3 and 4 had significantly greater changes than week 1 and that week 4 had significantly greater change than week 2. Conclusion: Microwave disinfection only promoted significant increase in OVD in Group 2, in which the values increased progressively.     

腓肠神经营养血管皮瓣修复跟骨骨折术后皮肤软组织缺损的临床研究

摘要 目的：探讨负压引流技术结合腓肠神经营养皮瓣在跟骨骨折钢板内固定术后皮肤软组织缺损的临床效果。方法：回顾性分析我院骨科2012年5月-2020年5月共31例跟骨骨折术后钢板外露,皮肤软组织缺损住院病人。纳入患者均使用负压引流技术结合腓肠神经营养皮瓣修复技术。创面给予彻底清创后行封闭负压吸引引流术,待创面新鲜后以腓肠神经营养皮瓣修复创面。对术后皮瓣成活情况;Maryland功能评分以及BMRC感觉功能评分进行综合评估。结果：术后2周时,28例皮瓣顺利成活,供区与受区伤口愈合良好,干燥、无渗出。3例术后出现皮瓣肿胀,皮瓣颜色发暗,伤口渗出较多,皮瓣边缘坏死,窦道形成等,给予切开引流、加强换药、敏感抗生素控制感染等治疗后,皮瓣成活。术后随访6-24个月皮瓣外观及功能恢复良好,无创面再坏死,裂开,感染等情况出现。其中2例再次入院行皮瓣整形术。术后6个月时,Maryland功能评分：优：17例;良：11例;优良率为：90.3%。BMRC感觉功能评分：S3-S4：20例;S2：8例;S1：3例。结论：腓肠神经营养皮瓣联合封闭负压吸引技术在跟骨骨折钢板内固定术后皮肤软组织缺损的治疗中能够缩短治疗时间,操作简单,疗效确切,可获得良好的修复效果。     

The ultrastructure of the swimbladder of the toadfish,Opsanus tau L.

Summary The anterior chamber of the swimbladder of the toadfish Opsanus tau L. is lined by a single layer of columnar gas gland cells, cuboidal cells that resemble gas gland cells but are located outside of the gas gland region, and squamous cells. Multilamellar bodies are numerous in the gas gland cells and the cuboidal cells and are present in smaller numbers in the squamous cells. Capillaries lie in the lamina propria directly below the epithelial lining. A thick continuous muscularis mucosae and a submucosa consisting of tightly packed cells, cell processes, and connective tissue may contribute to the impermeability to gases of the wall of the anterior chamber.The posterior chamber of the swimbladder is lined by a single type of squamous epithelial cell. Multilamellar bodies were occasionally observed in these cells also. Other types of cells frequently form a partial second layer between the epithelial lining and the basement lamina. A thin muscularis mucosae lies directly below the basement lamina and the capillaries of the posterior chamber are located in the submucosa. The tunica externa is a layer of dense connective tissue that surrounds both the anterior and posterior chambers. Collagen fibrils in the form of tactoids are present in this layer.Part of this work was submitted by S.M.M. in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Biology Department, Boston University. S.M.M. is grateful for a National Science Foundation Traineeship.     

Histology of the neurosecretory system and neurohaemal organs of the spider, Argiope aurantia (Lucas)

The oval olfactory rosette of the carp Labeo rohita belongs to Burne's ('09) rosette column one or to Bateson's (1889) rosette type three. The total olfactory area of the fish is greater than its total retinal area; however, it has been classified with Teichmann's ('54) group of eye-nose fishes. Each olfactory chamber communicates with an anterior, ventral accessory sac; in spite of Burne's ('09) observation that accessory sacs are absent in carps. Movements of the jaw bones dilate and compress the accessory sac. Water is drawn in through the posterior opening (and not through the anterior as suggested by Liermann, '33, and Johnson and Brown, '62) and also expelled through it when the mouth opens and closes for normal respiratory function. Hence, the accessory sac does not draw water across the olfactory rosette through the anterior opening. At intervals, the fish opens its mouth full and wide and draws water into the chamber through the anterior opening as well.     

Engineering a chemical implementation device and an imaging device for detecting chemiluminescence with a Polaroid™ high‐speed detector film: application to influenza diagnostics with the ZstatFlu®‐II test

We describe the engineering and product development of the chemiluminescent ZstatFlu®‐II Test kit for influenza diagnostics. The reaction vessel is a chemical implementation device with a polystyrene bottom chamber and a polypropylene top chamber that screw together. The patient's specimen is dispersed in a proprietary diluent and mixed inside the bottom chamber with the influenza viral neuraminidase‐specific substrate, 1,2‐dioxetane‐4,7‐dimethoxy‐Neu5Ac. Neuraminidase catalysis releases the dioxetane. The top chamber contains 40% NaOH and is sealed at the top with an ABS plastic plug‐crush pin assembly. The top chamber floor is 85% thinner at the centre, forming a frangible flap. An automated imaging device serves as an incubator for the chemical implementation devices and also facilitates the piercing of the flap by the crush pin. This action results in NaOH flushing into the bottom chamber, initiating chemiluminescence. The imaging device also exposes the Polaroid? high‐speed detector film to chemiluminescence. At the end of exposure, the film is automatically processed and ejected. Chemiluminescence from an influenza virus‐positive specimen produces a ‘+’‐shaped white image, archiving the diagnostic outcome. The modular ZstatFlu®‐II test kit components are easily adaptable for the chemiluminescent detection of a wide range of analytes. Copyright © 2003 John Wiley & Sons, Ltd.     

In-the-Bag Intraocular Lens Placement via Secondary Capsulorhexis with Radiofrequency Diathermy in Pediatric Aphakic Eyes

Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with a doughnut-like, extensively proliferative Soemmering ring.     

The comparison of marginal bone loss around mandibular overdenture‐supporting implants with two different attachment types in a loading period of 36 months

doi:10.1111/j.1741‐2358.2009.00334.x
The comparison of marginal bone loss around mandibular overdenture‐supporting implants with two different attachment types in a loading period of 36 months Objective: The aim of this study was to assess the influence of attachment types on the marginal bone loss (MBL) around dental implants supporting mandibular overdentures (OVD). Background: There are a number of in vitro studies evaluating the influence of several factors on MBL around implants. Material and methods: Mandibular OVD patients appearing at routine recall sessions consecutively 6, 12, 24 and 36 months after loading were included in the study group. All patients received mandibular OVD with either ball or bar attachments. Measurements were obtained from images of successive radiographs, which were scanned and digitised before, and analysed at ×20 magnification. Statistical analyses were utilised in this study to assess the mean marginal bone level changes as well as to explore the potential effect of several parameters such as the cantilever or the attachment type on bone loss. Results: One hundred and twenty‐six implants in 51 patients with a mean age of 59.39 ± 9.99 years were evaluated. There was no statistical significant difference between the distal and mesial bone loss rates of single or splinted attachment types, whereas bone loss rates were statistically higher in cantilever situations. Conclusion: Within the limitations of this study, gender, age and diameter of the implants do not play a role in MBL. Length of the implant is an important factor in marginal bone level maintenance. The attachment type for OVD support seems not to influence MBL, but cantilevering of the bars increases bone loss significantly.     

Characterization of intermittent bursts at the edge of the CASTOR tokamak

Temporal characteristics of density bursts in the scrape-off layer of the CASTOR tokamak were investigated. Intermittent positive bursts of density are observed by means of a radial array of Langmuir probes. Globally (comparing the closest and furthermost radial positions with respect to the center of the discharge chamber) we observe a radial decrease of average burst rate together with a radial increase of the average burst duration. Recently, we observed a monotonic radial decrease of average burst rate together with an increase of the average burst duration in the Tore Supra tokamak [1, 2], but the decay length is significantly shorter than in CASTOR. This is most probably due to radially elongated turbulent events (streamers), which govern the radial transport at the edge of the CASTOR tokamak [3] and are responsible for the appearance of density bursts. Published in Russian in Fizika Plazmy, 2008, Vol. 34, No. 9, pp. 781–785. The text was submitted by the authors in English.     

Reliability and comparison of two facial measurements to detect changes of occlusal vertical dimension in complete denture wearers

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00353.x
Reliability and comparison of two facial measurements to detect changes of occlusal vertical dimension in complete denture wearers Background: Facial measurements are frequently used to determine OVD. However, the reliability of neither the method nor the chosen landmarks has been cleared yet. Objective: This study compares the reliability of two facial measurements, subnasal (SN) to chin (C) and tip of the nose (TN) to C, for determining occlusal vertical dimension (OVD). Materials and methods: Thirty edentulous subjects with adequate neuromuscular co‐ordination, without signs and symptoms of temporomandibular disorders and who had been wearing complete dentures for at least 5 years were enrolled. A modified central bearing device was used to alter the OVD and facial measurements were made with a digital caliper. Student’s t‐test was used to compare the two measurements. Interobserver and intraobserver reliability were evaluated with Spearman’s rho correlation test. Results: TN–C distance had an improved correlation with the changes in intraoral alterations than SN–C distance. While the means of the changes in facial measurements were in good agreement with the intraoral alterations, the ranges were wide. Both interobserver and intraobserver reliability of the measurements were high. Conclusion: While facial measurement is not a good predictor of OVD, TN–C distance appears to be more reliable than SN–C distance.     

Innervated radial thenar flap combined with radial forearm flap transfer for thumb reconstruction

A radial thenar flap combined with radial forearm flap was used for the reconstruction of the ipsilateral thumb in four patients. Vascular supply of the combined flap was based on the radial artery and extending the vascular pedicle to the superficial palmar branch of the radial artery. The flap was sensated by the palmar branch of the superficial radial nerve. The size of the flap averaged 15 x 5 cm and the innervated region of the thenar eminence was an area approximately 5 x 3 cm located over the proximal parts of the abductor pollicis brevis and opponens pollicis muscles. The flap was transferred as a free flap in three patients and as an advancement flap in one patient. The flaps survived completely without complications. Satisfactory restoration of sensation was achieved in the flap area, as shown by 6 mm of average moving two-point discrimination. This combined flap may be a feasible reconstructive option for large palmar defects of the fingers such as degloving injuries.     

Underwater observations of the rare deep-sea fish <Emphasis Type="Italic">Triodon macropterus</Emphasis> (Actinopterygii,Tetraodontiformes, Triodontidae), with comments on the fine structure of the scales

Underwater observations of two living individuals and an examination of a freshly dead individual of the rare deep-sea fish Triodon macropterus revealed that they usually have the large ventral flap completely uplifted and seamlessly retracted into the abdominal region of the trunk: one individual was collected at a depth of 280 m by hook and line east of Tonaki-jima Island, Ryukyu Islands, and kept in a tank at the Okinawa Churaumi Aquarium for six years; the second living individual was observed by the ROV Hakuyo 2000 at a depth of 275 m east of Ishigaki-jima Island, Ryukyu Islands; and another individual collected at depths of 250?350 m by hook and line off Funchu Point, Yoron-jima Island (27°00.15’N, 128°26.06’E), Ryukyu Islands, provided an opportunity to demonstrate that the ventral flap could be manually uplifted by rotating the pelvis. When the ventral flap was uplifted in all of these specimens, whether naturally or manually, there were no scaleless linear bands or streaks and gaps evident in the skin between the retracted ventral flap and the abdominal region. The fine structure of the scales of the body and the ventral flap was observed by light microscopy, scanning electron microscopy, and X-ray CT scanning. The scales of the ventral flap are arranged in rows radiating from the antero-dorsal part of the ventral flap where the anterior part of the pelvis articulates with and rotates around the pectoral girdles. The orientation of the rows on the ventral flap changes from a posterior direction dorsally to a posteroventral direction more ventrally. A ridge with many sharp serrations is raised and bent from the edge of each scale on the body and ventral flap. The raised ridges on the lower scales on the ventral flap become packed together with the upper scales to form a seamless surface when the ventral flap is uplifted into the abdominal region.     

Late Manifestation of Tracheal Rupture After Thyroidectomy: Case Report and Literature Review

ObjectiveTo report an extremely rare case of delayed tracheal rupture after thyroidectomy and to review the existing related literature.MethodsWe present the history, clinical findings, radiographic evaluation, management, and intraoperative findings in a patient who presented with subcutaneous emphysema 9 days after total thyroidectomy. In addition, we review the literature and discuss the diagnostic challenges as well as management options.ResultsA 17-year-old female patient underwent a total thyroidectomy for Graves disease. On postoperative day 9, the patient presented with face and neck swelling attributable to subcutaneous emphysema. After conservative management failed, the patient underwent surgical exploration of the neck, which revealed a 2.5-cm linear vertical tear in the anterior aspect of the trachea, with no evidence of necrosis. The tear had viable edges and was primarily repaired with use of muscle flap reinforcement. The patient recovered with no other complications.ConclusionDelayed tracheal rupture should be suspected in all patients who present with subcutaneous emphysema after a thyroid surgical procedure. Review of the pertinent literature suggests that conservative management is suitable in patients with a stable condition. Surgical repair is indicated in those patients who fail to demonstrate clinical improvement. (Endocr Pract. 2012;18:e73-e76)     

Intermediate fenestrations reduce flow reversal in a silicone model of Stanford Type B aortic dissection

Pulsatile, three-dimensional hemodynamic forces influence thrombosis, and may dictate progression of aortic dissection. Intimal flap fenestration and blood pressure are clinically relevant variables in this pathology, yet their effects on dissection hemodynamics are poorly understood. The goal of this study was to characterize these effects on flow in dissection models to better guide interventions to prevent aneurysm formation and false lumen flow. Silicone models of aortic dissection with mobile intimal flap were fabricated based on patient images and installed in a flow loop with pulsatile flow. Flow fields were acquired via 4-dimensional flow MRI, allowing for quantification and visualization of relevant fluid mechanics. Pulsatile vortices and jet-like structures were observed at fenestrations immediately past the proximal entry tear. False lumen flow reversal was significantly reduced with the addition of fenestrations, from 19.2 ± 3.3% in two-tear dissections to 4.67 ± 1.5% and 4.87 ± 1.7% with each subsequent fenestration. In contrast, increasing pressure did not cause appreciable differences in flow rates, flow reversal, and vortex formation. Increasing the number of intermediate tears decreased flow reversal as compared to two-tear dissection, which may prevent false lumen thrombosis, promoting persistent false lumen flow. Vortices were noted to result from transluminal fluid motion at distal tear sites, which may lead to degeneration of the opposing wall. Increasing pressure did not affect measured flow patterns, but may contribute to stress concentrations in the aortic wall. The functional and anatomic assessment of disease with 4D MRI may aid in stratifying patient risk in this population.     

Sex Difference in Contusion of the Medial Femoral Condyle Rim-Association with MRI Occult Meniscal Tears in the ACL Deficient Knee

BackgroundMeniscal tears, specifically lateral meniscal tears, have a larger than expected un-derdiagnosis rate in the presence of an ACL tear. The purpose of our study was to search for an MRI bone contusion pattern associated with MRI occult meniscal tears in patients with an ACL tear, specifically a contusion of the rim of the medial femoral condyle (RMFC). Our hypothesis was that there would be a significant association between RMFC contusions and MRI occult meniscal tears in patients with an ACL tear. We also searched for a difference between sexes with respect to the presence of the RMFC contusion in the setting of an occult meniscal tear. We also categorized the type, size, and location of these occult meniscal tears in the setting of an ACL tear.Methods This was a retrospective study that examined characteristics of occult meniscal tears and their association with a RMFC bone contusion. IRB approval was obtained. The date range of the study was June 2009 through December 2015. 6392 consecutive knee MRI reports in patients with an ACL deficient knee were reviewed. The study group included 22 patients with MRI occult meniscal tears, the control group included 110 patients. Relevant statistical values were calculated.ResultsThe most common type of occult meniscal tears were small radial and small longitudinal tears of the lateral meniscus. Occult meniscal tears were associated with an RMFC contusion in the study group (p=0.0457), particularly in males (p = 0.0003). In males with a torn ACL, the sensitivity of an RMFC contusion for an occult meniscal tear was 80%.ConclusionIn males with an ACL tear, there was a significant association between a contusion of the RMFC and an occult meniscal tear (commonly small radial or small peripheral partial-thickness longitudinal tears). RMFC contusions were reliably identified by radiologists in this study.Level of Evidence: II     

经桡动脉心导管术诊断和治疗冠状动脉疾病的临床研究

目的:观察经桡动脉介入诊治冠心病的安全性和有效性。方法:对1503例患者进行了经桡动脉途径介入诊治,其中包括心绞痛患者1218例,心梗患者268例,二尖瓣和/或动脉瓣手术前对冠状动脉进行解剖学评估17例,观察患者手术安全性、成功率以及与经桡动脉手术相关的并发症发病率。结果:介入治疗成功率为93.1%(1400/1503),手术失败的主要原因为桡动脉穿刺失败(39例),严重桡动脉痉挛(42例),右锁骨下动脉不同程度的弯曲(18例),近端严重狭窄(14例)。术后有14例患者出现严重并发症(瞬时缺血性病变),60例出现有症状的窦性心动过缓,43例出现静脉血栓,77例出现血肿,88例出现桡动脉梗阻。结论:经桡动脉途径是一种安全、有效、患者更容易接受的冠心病介入诊治方法。     

Application of the cross-bridge microvascular anastomosis when no recipient vessels are available for anastomosis: 85 cases

The purpose of this article is to introduce the results of free tissue transfers using the technique of the cross-bridge microvascular anastomosis when the recipient lacks suitable vessels for anastomosis. Between May of 1982 and June of 2002, a series of 85 patients underwent this procedure. The transferred tissues were the free latissimus dorsi myocutaneous flap, the free vascularized fibula, the free fibular osteocutaneous flap, and the free iliac osteocutaneous flap, alone or in combination. The donor vessels were the anterior tibial artery and great saphenous vein, the posterior tibial artery and its venae comitantes, and the radial artery and cephalic vein. Good results were achieved. The success rate reached 95.29 percent. The authors believe this procedure can be performed in the event of serious tissue defect where the vessels are unsuitable for anastomosis.